Individual provider Active NPI

Kimberly Ann Miles, MSW LICSW CDP

  • Clinical Social Worker
  • Seattle, WA
National Provider Identifier
1003250960
Registry record updated Mar 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LW60455301 Issued in WA
Practice address
1101 Madison St Ste 301
Seattle, WA 98104-3599
Phone
(206) 621-4618
NPI assigned
Apr 23, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X CP60091478 WA
Clinical Social Worker 1041C0700X LW60455301 WA Primary

Addresses

Primary practice location

1101 Madison St Ste 301
Seattle, WA 98104-3599

Mailing address

1145 Broadway
Seattle, WA 98122-4201
Phone (206) 329-1760

Other names 1

  • Ms. Kim Ann Miles Other name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kmiles1045568@wm.providencedirect.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140926001656 WA Practitioner - Clinical Social Worker 0446470348 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Pacmed ClinicsGroup PAC ID 2466350657, 211 clinicians

Practice addresses (Care Compare)

31833 B Gateway Ctr Blvd S
Federal Way, WA 98003-5616
Phone (253) 214-1920

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CP60091478WAMDAddiction (Substance Use Disorder) Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Kaiser Foundation Health Plan of Washington CurrentSince Jun 24, 2014 Accepting new patients
Pacmed Clinics CurrentSince Dec 26, 2018 Accepting new patients
Pacmed Clinics Current Accepting new patients
Pacmed Clinics CurrentSince Dec 26, 2018 Accepting new patients
Kaiser Foundation Health Plan of Washington CurrentSince Jun 24, 2014 Accepting new patients

Locations

31833 Gateway Center Blvd S
#B
Federal Way, WA 98003
Phone (253) 214-1920

220 15th Ave SE
Puyallup, WA 98372
Phone (253) 435-3400

200 15th Ave E
Seattle, WA 98112
Phone (206) 326-4530

1101 Madison St
Ste 301
Seattle, WA 98104
Phone (206) 505-1101

9505 S Steele St
Tacoma, WA 98444
Phone (253) 597-6800

Interoperability endpoints

  • Direct secure messaging: kmiles1045568@wm.providencedirect.org

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1366675200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614556800000",
    "number": "1003250960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1145 BROADWAY",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981224201",
            "telephone_number": "206-329-1760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 MADISON ST STE 301",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981043599",
            "telephone_number": "206-621-4618"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILES",
        "first_name": "KIMBERLY",
        "middle_name": "ANN",
        "name_prefix": "Ms.",
        "credential": "MSW LICSW CDP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-04-23",
        "last_updated": "2021-03-01",
        "certification_date": "2021-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "CP60091478",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "LW60455301",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kmiles1045568@wm.providencedirect.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1101 Madison St Ste 301",
            "city": "Seattle",
            "state": "WA",
            "country_code": "US",
            "postal_code": "981043599",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KIM",
            "last_name": "MILES",
            "middle_name": "ANN",
            "prefix": "MS.",
            "credential": "MSW LICSW CDP",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Seattle, WA

Sources for this page

Verify at the official NPI Registry.